Shift 63 and 64

Shift 63:
Nothing to report as I had to call in sick.  Been fighting a stomach bug of sorts- fever, body aches, headaches and stomach junk. Been sick since Thursday and even with Thursday and Friday off, I still wasn't feeling better so I called in sick.  I hate doing that but what can I do?

Shift 64:
Oh how badly I wanted to call in again today, but I really didn't want to call in two days in a row.  So I went in.  It was a slow day all during day shift.  I literally sat around most of the day.  About 2 hours before shift change, I went into triage.  Then at shift change I had to take an assignment.  My charge nurse felt bad about that, knowing that I didn't feel well, but we were really short staffed.  I had three rooms until 11pm and then I had 4 rooms assigned to me. I had everything from back pain, to pink eye, to hip fracture, to chest pain, to shortness of breath, to pain in the esophagus. I struggled through my shift but I made it.  Nothing really interesting or fascinating to report.

For now, two days off, where I will hopefully be feeling better, and then back to two shifts back to back on Wednesday and Thursday.  Until then......

Shift 61 and 62

Shift 61:

Not a bad shift.  Nothing really interesting to report.  Things seem to be getting easier and easier for me and I am getting less stressed.  I realize how much I enjoy working with the night crew.  I work 5 hours with the day crew and the other 7 are with the night crew.  The night people are fun and there are more times when there is down time with nights than with days.  I would totally want to work day shift for the hours if it wasn't for the fact that I would no longer work with the night crew.

Shift 62:

Today, I think its possible we are the only ER open.  Fire rescue after fire rescue, walk in after walk in.  Non stop ALL day, even into the night shift.  It slowed down, but it did not stop.  When I left my last shift, there were 3 patients in the ER.  Tonight when I left, we still had all the rooms filled and just one hallway patient (we have 10 possible hallways beds available on top of the rooms we have).  It was crazy.  Nothing interesting to talk about.  Glad I have 2 days off before having to do it all again.  I'm dreading the next 4 shifts because we are extremly short staffed on nights all 4 of those shifts.  I am hoping and praying that changes by then.  We shall see. 

For now, I have 2 days off and I am going to enjoy them. Until then :)

Shift 58, 59 and 60

Sigh.  Even with 4 days off, I am still struggling to write my blog.  So here goes- short and sweet.

Shift 58

Not too busy and nothing interesting to talk about.  It was my first shift of three in a row and I worked with two awesome charge nurses.

Shift 59

Today was also not too busy of a day.  But we did have a couple of interesting patients in the ER today. One was a young man who came in (wasn't my patient) and turned out one of his lungs were deflated.  He needed a chest tube put in to "reinflate" his lung.  I got to watch.  It was my second time ever watching this done and the first time in the ER. Second patient was brought in by family members who asked one of the staff workers in the parking lot where the ER entrance was and if there was a quicker way to get in.  Behind them was another family member running up with a limp, unresponsive 3 year old.  They quickly came in through the side door, wheeled a patient out of one of the rooms, and moved her onto a bed and into the room.  Patient started seizing and vomiting.  Apparently, she was asleep and vomited, family member went into check on her, and she was not waking up.  She was breathing and had a pulse, but was responsive.  We took her to cat scan, and then when she returned the ER doc made the decision to intubate her in order to protect her airway because she had seized again and had also vomited.  We do not have a peds unit in our hospital so we had to transfer her to another hospital.  That was pretty much the extent of our care for her.  And that was pretty much it for my shift.

Shift 60

I don't know what happened, but when I got in, it was already going crazy.  It was so busy.  My charge nurse had me go up front to triage to relieve someone for their lunch break, and that person never came back.  So I stayed up there from 2 until 7pm when it was shift change.  At one point, we had myself and another nurse up front triaging patients because we got backed up.  In the back, we had fire rescue after fire rescue bringing in patients.  Finally after shift change it started to slow down and was never really bad after that.  I don't even think we had any fire rescues come in after 8pm until I left at 2am.  When I left at 2am, there were only 3 or 4 patients in the ER.  Nothing really interesting happened this shift.

I work again tomorrow, so stay tuned for more soon.

Shift 56 and 57

Shift 56:

The shift started out with me walking in the door, past my director's office, who ended up stopping me and telling me that he resigned that morning.  His last day in the beginning of June.  His assistant/clinical coordinator had already gave her notice as she and her family were moving back home to another state.  Her last day is mid-June.  So, there will be a lot of changes coming in June.  I'm not sure if I should be afraid or excited.  The new people could be amazing, or they could be terrible.  Actually, I think some of our current nurses are interviewing for the assistant/clinical coordinator position, so that will be nice the person who is hired is one of them.

Anyway, today was very busy.  We had an extra nurse on the floor, so that was helpful.  I had two patients during this shift that had to be admitted to ICU.  The first patient I had before shift change.  Another nurse on the floor had a patient that needed to go to ICU as well, and ICU happened to be full.  So an ICU nurse came down and took care of the patients in our ER.  I started taking care of the patient who would become my second ICU patient when one of the ICU patients that were being taken care of in our ER was downgraded from ICU status and was able to go to one of the other floors.  I waited for the admitting doctor to call back to admit my second ICU patient, and it was nearing the end of my shift.  I was hoping to get out at 2, but unfortunately, the charge nurse who was working rarely lets me out right at 2.  At 2:15 the doctor calls, and I had to take orders. By the time that was done, I had to give that patient some stat meds.  That took a little time, and by that time, my other 2 patients were up for discharge.  I had to spend a little time discharging them, and then it was time to give report to the ICU nurse on my ICU patient (we give a report about the patients to the nurses to catch them up to speed about what is going on), but the nurse was busy at the moment.  Then I realized I had to fill out some more paperwork about the patient, and I had to do a screen for admissions in the computer that usually I don't have to do but this particular charge nurse makes us nurses do it.  By that time, it was 3:40am and I was finally able to walk out.   If only I had left at 2, I would have avoided all that mess.  But at least I didn't have to work the next day, and I had 2 days off, and I got some overtime so I guess I can't complain.  Even though it was a busy day, I seem to be handling the stress better.  I've noticed this with some of the busy days we've been having lately.  That's a good thing.  I'm getting closer to the halfway mark of my first year and I have learned and grown so much, but there's still a long way to go.  

Shift 57:

Today was a relatively slower day.  It wasn't "slow", but definitely better than the other day.  It stayed pretty steady most of the day, but nothing stressful.  After shift change, I was floating, and it started slowing down pretty well.  At midnight, my charge nurse asked if I wanted to go home, and I said yes since today was Mother's Day and I didn't want to have to sleep in too long like I would if I got out around 2.  It was a good shift.  I actually looked forward to going into work this shift.  Maybe it was because of who was going to be charge nurse for the night shift, but regardless, I am feeling better and better about going to work. I really just think I am still trying to adjust to not being off whenever I want to be and with not being able to be with my kids and family like I used to be when I was a stay at home mom.  In time I will feel better about that.  I am slowly adjusting.  I was off for 9 years and its going to take time to get used to not having the same freedoms I had before.  But the good thing is I only work 3 days a week, so I still have a lot more freedom that a lot of working people.  And I get to help people in the process.

I have three days back to back this week, so I am going to be exhausted.  I will write when I can, but it might be Wednesday after the third shift.  Then I have a wonderful 4 days off, including my first full weekend off in a month!  I am so looking forward to that.  Until then......

Shift 54 and 55

Shift 54:

The shift started out good.  It wasn't busy, but not super slow.  Around 11/11:30pm it started picking up and got really busy.  At that time of the night, we only have 1 doctor, so he started getting really backed up.  He finally asked if the charge nurse could call the doctor who is the head doctor (I believe he is the "medical director" of the ER) and ask him to come in. At 1 or 2am he came in to help.  We had every bed filled, and 4 or 5 hallway beds full as well.  The nurses were working together as an amazing team......I never once felt stressed.  We were all helping each other.  However, I didn't leave until nearly 4am (yikes!  I work 2pm to 2am).  I had a patient that came in with shortness of breath- a young girl, I think about 28 or 29.  We hooked her up to the monitor and her heart was beating a little fast, what we call sinus tachycardia, which is 100-150 beats per minute.  She was around 110 or so.  Then, a tech was in the room with her and she said she didn't feel well all of a sudden, and her heart rate went crazy- 250!!! We call that SVT- supraventricular tachycardia, which is from 150 to 300 beats per minute.   The doctor and I went in there, and he had her bear down as if she were having a bowel movement (what we call a vagal maneuver- the bearing down stimulates the vagus nerve, which slows down the heartrate).  Her heart responded and then she went back to sinus tach.  A little later, she went to have a CT.  When she was being rolled back into her room, she didn't look too good, so I told the tech to hurry and get her back on the monitor, and sure enough, she was at 225 beats per minute again.  I told the doctor to come because she was in SVT again and that the vagal maneuver wasn't working. At that point, he said we needed to give her adenosine, which is  a medicine that slows that heart down, and sometimes so much so it may nearly come to a complete stop, so whenever you administer this medication, you must attach defibrillator pads to the patient (some machines have sticky pads that you just stick on, and some machines have actual paddles- we have the pads in our ER). I went to get the meds, a tech went to get the defibrillator.  Then I administered one dose of adenosine and it did not convert her heart rhythm to sinus tach.  It barely did anything to her heart.  I then administered a second dose of adenosine.  Still nothing.  Barely any change.  The doctor then decided we'd try cardizem, which is in a class of medications called Calcium Channel Blockers.  Essentially, they block calcium from entering the heart cells and blood vessels, therefore causing a relaxation effect and widening of the blood vessels and also relaxation of the heart muscle.  This lowers blood pressure and slows down the heart rate.  I gave her some cardizem in her IV and it finally converted her heartrate back down to 130.  I gave her some more a little while later as well, but her heartrate still lingered at 130.  At that point, it was time for me to go home.  When I came in the next day (shift 55), I was thinking about stopping to see her in her room.  She had been really scared the night before, and was crying because she didn't want to die and she really thought she was.  She wanted to call her mom in another state but was debating it because she didn't want her mom to worry, but at the same time she thought if she was dying, she wanted to talk to her mom again.  I comforted her, told her she should call her mom, but to remain calm and just tell her mom she wasn't feeling well and was at the hospital.  I also reassured her that she was in the right place to be sick and that we'd do all that we could to help her get better.  Anyway, I wanted to see how she was doing, and lo and behold, she was still in her room in the ER.  Apparently, she was going to be admitted to ICU, but there were no ICU beds available, so she had to stay down in the ICU (its what we call an ICU hold) and an ICU nurse usually comes to take care of that patient.  The nurse who took over for me when I went home the night before is an ICU nurse, she just floats to the ER to help sometimes, so she took over that patient's care until shift change.  Then another ICU nurse took over.  By the time I came in, the cardiologist had just downgraded her to telemetry, which is a little more acute (sick) than just a medical-surgical floor, and these patients have to be on a cardiac monitor 24/7.  She was actually just getting ready to go up to her room.  I was glad she was doing better and her heartrate was beating in the 70-80 range, which is awesome!  Anyway, that was my exciting experience of the night, my exciting new experience, however, it was unfortunate for the patient.  But I am glad I got to be her nurse to be there for her when she needed someone.  I hope I helped her feel as though  she was taken care of, and taken care of well for that matter. And most of all, I am glad she is doing better.

Shift 55:

Relatively slow day. At one point, we almost had an empty ER.  We had about 5 patients and they were all just waiting to go upstairs (they were already seen, treated and admitted).  We sent 2 nurses and 1 tech home early.  Then around 5pm or so, we started picking up a bit and it lasted until 9:30pm or so.  Then it slowed down again.  I probably would have been able to go home early, except for the fact that there were only 2 nurses who came in at 7pm, so when I left, there would only be 2 nurses left on the floor.  

Shift 56 is Wednesday, and then I am off again for 2 days.  Until then.....

Shift 53

It was a steady day.  Busy but not terrible.  A good busy, as I like to call it, where its slow enough where I can keep caught up with my patients but not too busy where I am going crazy.  We were staffed well, so it was a good day.  I had received a 3 room assignment when I got in, and then at shift change I got a new 3 room assignment.  Nothing interesting or anything.    Oh well, I forgot, as soon as I clocked in I heard the code alarm go off.  Fire rescue came in with a code, but really it was pretty uneventful because the doctor called it just as soon as the patient was in the room.  Fire rescue had already worked the code in the field for 45 minutes, so there was really nothing more we were going to be able to do.  Sad, but true.

And that's all folks.

Shift 54 and 55 this weekend......stay tuned.

Shift 52

The day before shift 52, I had the migraine of all migraines.  Hadn't had one so bad in a REALLY long time.  Before bed, I took 2 fioricets (migraine meds) and went to bed.

The brunt of the migraine had subsided, but I still felt the pressure in my head, I was still sensitive to light, and I still felt a little foggy.  I went into work at 2pm and thank goodness it was slow.  It was an uneventful day.  I had a 4 room assignment from 2p until 7p when the shift changed.  Then I went to triage.  I had asked the charge nurse if there was any possibility I could go home early and she told me she would try.  We had 5 nurses on the floor, plus the charge nurse, but we only had one tech, so I guess she was going to see how it went.  I went on my break at 10:30pm which really wasn't a big deal because I don't really like to go early, and it seems to make time go by better if I have less time left after my break.  I get back from break, ran up to one of the floors with the ER doc for a code (we don't usually do this, I just wanted to see it on the floor) and then I get back to triage.  At that point its 11:15pm and about a half an hour later, the nurse who relieved me for my break came to relieve me to go home.  So I left at 11:45pm which was nice.  But it was a really good day over all.  Just wish I hadn't been trying to recover from this migraine.  I still am trying.

Shift 53 is Thursday.  Stay tuned until then.